Action Points

This appears to be due to the fact that fewer women present themselves within 4 hours from stroke onset than men.

Among patients presenting with an acute stroke, women were less likely than men to receive intravenous thrombolytic therapy, which could have to do with delayed arrival at the hospital, researchers found.

In a cohort of patients presenting within 24 hours of stroke onset, IV tissue plasminogen activator (tPA) was used in 11% of women and 14% of men (OR 0.8, 95% CI 0.7-1.0), according to Inger de Ridder, MD, of Erasmus Medical Center University Hospital in Rotterdam, and colleagues.

In the subgroup of patients who presented with an acute ischemic stroke within 4 hours of symptom onset, however, the sex difference disappeared (41.6% versus 42.4%, OR 1.0, 95% CI 0.8-1.2), the researchers reported online in Stroke: Journal of the American Heart Association.

"Fewer women present themselves within 4 hours from stroke onset than men and consequently less often receive thrombolytic treatment," they wrote. "This difference may be caused by the older age of women on average and consequently women more often living alone," which would increase the chances of having a stroke that is not witnessed.

The authors noted, too, that "although age is not a contraindication for treatment, physicians may be less inclined to treat older patients."

To explore the issue further and look for reasons for the sex difference, de Ridder and colleagues turned to the Promoting Acute Thrombolysis for Ischemic Stroke (PRACTISE) study, which included 5,515 adults (50.4% female) who presented to one of 12 Dutch hospitals with an acute stroke within 24 hours of onset.

Compared with the men, the women in the study had a higher average age (74 versus 70) and median NIH Stroke Scale score (6 versus 5).

After adjustment for age in the overall cohort, the women still were less likely to receive thrombolytic therapy compared with men.

That was at least partly explained, however, by the fact that women were less likely to present to the hospital within 4 hours of symptom onset (27% versus 33%, OR 0.8, 95% CI 0.7-0.9) and had a significantly longer onset-to-door time (by 27 minutes, 95% CI 9-47).

There were no differences between men and women in rates of hemorrhagic stroke, the percentage of patients who called a general practitioner or who were visited by one, or in the proportion who had contraindications to thrombolytic therapy.

"The impact of sex differences in treatment of acute stroke is huge: about 25% more women should be treated with alteplase to abolish the difference, and this number is increasing with the aging population," according to the researchers.

"Therefore, further research is needed to understand the reasons why fewer women with acute stroke are admitted in time for treatment to be able to deal with this inequality," they wrote.

The authors acknowledged that the current study was limited by the sparse demographic information available for the patients and by the possibility that the data, which were collected from 2003 to 2005, were outdated.